Ok, that's what I figured I would do, just kinda go along with it when they talk about bringing her in every couple weeks to have the blood glucose testing done. Just from what we've learned on here in the short amount of time we've been here told me that it's perfectly safe and better to do that testing at home, so that is what we plan on doing.

I have not heard back from DCIN yet, I plan on emailing them when I get back from the store to make sure they've seen the application.

I have to work in about an hour and a half, so I'm going to go get more food to make sure Dan has enough here to keep up with feeding her for the night and someone mentioned giving her some plain pedialyte so i'm going to get that too.

I want to give her some of the pepcid but i'm not sure how we're supposed to do it. We guessed maybe we can crush it up and mix it with a little bit of the baby food we've been giving her? If that's not right please correct me, I'd like to try it to see if it will help at all.

I wish I would've asked what kind of insulin they would prescribe her. Is it something that depends on the cat for what kind they write it for or do you think they write it for the same kind for all?

They said we can give her 1/4 of a tablet of the pepcid ac as long as its the famotidine kind for nausea. I got some yesterday but didn't want to give it to her since I didn't have the ok from the vet yet. The one I got is 20mg tablets, I looked for 10 mg but couldn't find any. She told me I should go back and try to find the smaller mg one, which I will do in a few minutes. When I get it how should we give it to her?

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If you can't get the 10mg famotidine tablets you can split the 20mg tablets into approximately 1/8 tablet dose. Some of the tablet will crumble a bit but you'll be able to get a piece that's the right size; it'll be just fine. (Can't get the 10mgs over here so I split the 20mg tabs.)

To give the 1/8 tablet try this method:

Kneel on the floor with Mittens between your thighs, back towards you and facing away from you.

Tilt her head back and ease open her jaws with thumb and forefinger. You need to see the back of her tongue.

Gently drop the 1/8 tablet into her mouth so it lands on the back of the tongue.

Keep Mittens' mouth closed and very gently rub her throat - it will encourage her to swallow the tablet.

Syringe about 3-5ml of water after giving the tablet to wash it down properly.

Keep an eye on her for a minute or two to make sure she doesn't spit it out!

Is it something that depends on the cat for what kind they write it for or do you think they write it for the same kind for all?

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Most vets have a "go to" insulin that they use for all their patients....Unfortunately a lot of times it's an insulin that's better for dogs than cats (since they see more diabetic dogs) called Vetsulin ....but that's a veterinary insulin so if they're talking about you getting your insulin at a human pharmacy, they're probably talking about Lantus or Novolin

There's a big difference in how Lantus and Novolin work and while NPH (WalMart's brand of Novolin) is better than nothing, it's really better to spend the $ if you can and get the Lantus

If its lantus she is talking about, the solostar pen is cheaper and less insulin than the vial.

Given what we've seen of this vet so far, i'm not surprised she doesnt like that you're home testing. Keep home testing it is much more accurate and much cheaper, and you dont have to tell the idiot vet about it.

With the holiday weekend upon us, I'd try to delay the labs (saving money) until after Christmas - by which time you may have found another (better) vet. Ask the vet exactly what each lab test is for and how necessary is it? Explain that it is Christmas and money is tight. You probably won't by getting the results until after Christmas anyway.

Ask for a script and also ask if the vet has a part bottle of Lantus they could sell you. Check it first for air bubbles (you don't want to inject air into the vial) and check to make sure it is clear (particles or cloudiness indicates the Lantus has gone bad).

I'm just catching up here. I agree with all the others about your vet. I could just slap the women that told you treatment wouldn't help. HOGWASH !!!!!!

Poor baby not feeling well and doctors won't help. They need to be reported. I know from reading here you are doing everything you can. I so hope you can at least get the N going until you can see another vet

If your vet had diabetes or one if his kids did, should they be put down. I'm pissed enough to actually ask them that face to face.

Sorry for rant. Prayers and hugs to you. Wish I had some left to send you.

Following on from Red's post above, I'd suggest following Meya's recommendation to get a test done for potassium levels.

If the vets office offer a SNAP fPL test for pancreatitis that might be worth considering tomorrow. It gives an on-the-spot Yes/No result for abnormalities in the pancreas. Pancreatitis can cause pain, especially when food is ingested. If Mittens were to have a positive result you might be able to get the vet to prescribe pain meds for her tomorrow (buprenorphine) and if she has pancreatitis the pain relief along with an anti-nausea med could help her eat better.

(For info, there are also Spec fPL or equivalent pancreatitis blood tests which give a numerical result indicating severity of inflammation. If a kitty has pancreatitis then the number returned by this test doesn't change the treatments that the kitty needs to receive. If the SNAP test is available and shows positive you should not need a Spec fPL test.)

Just in case you might need them to help your vet discussions, maybe print out the following and bring it with you to the appointment:

Thanks again to everyone for all the replies and help. Ill make sure we have a good set of notes for us to use tomorrow with the vet.

Just a small update: I just got another urine sample for the ketone strips and it came back "small". Ive been feeding her with the syringe every 2-3 hours, depending if shes sleeping or not(i try to let her rest when she looks comfy). We also got some non flavored pedialyte and mixed it about 60% water and 40% pedialyte? I read online half and half, but wasnt sure, gonna try to give her some of that soon. She ate a little bit of food today on her own but not very much. I kind of wanna wait til Heather is off work to try the pepcid because it might be easier.

Im sure my wife will be on here as soon as she gets a break, shes a little more informed than me since she was the one on the phone with the vet and the one on here replying lately. Im trying to catch up on the thread now though.

I have often seen it recommended that anything above a trace in ketones should be referred to a vet. I would keep that food coming (every couple hours, through the night, too) and do your best to keep her hydrated and eating. My cat J.D. was a DKA survivor. He had to be hospitalized for over 8 days. The recipe for DKA is not enough food, not enough insulin, and an infection or other stress. DKA can come on very quickly. I don't want to scare you. You are doing such a good job of trying to help her. I just want you to be aware of the importance of getting food into her and keeping her hydrated. I'm glad you'll be getting the fluids tomorrow, and some insulin, and hopefully some meds to help her to eat on her own better. Is your appointment in the morning?

I have often seen it recommended that anything above a trace in ketones should be referred to a vet. I would keep that food coming (every couple hours, through the night, too) and do your best to keep her hydrated and eating. My cat J.D. was a DKA survivor. He had to be hospitalized for over 8 days. The recipe for DKA is not enough food, not enough insulin, and an infection or other stress. DKA can come on very quickly. I don't want to scare you. You are doing such a good job of trying to help her. I just want you to be aware of the importance of getting food into her and keeping her hydrated. I'm glad you'll be getting the fluids tomorrow, and some insulin, and hopefully some meds to help her to eat on her own better. Is your appointment in the morning?

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Yes our appointment is at 11am, I just gave her some pedialyte/water and a portion of the chicken and broth baby food and will continue to do so every couple of hours for the rest of the night, she tries to walk away from me halfway thru feeding but she gives in easy enough to let me feed her a little more. Im really hoping tomorrow brings some good news and maybe she starts to feel better. Thank you and everyone else here for all the help lately

Yes our appointment is at 11am, I just gave her some pedialyte/water and a portion of the chicken and broth baby food and will continue to do so every couple of hours for the rest of the night, she tries to walk away from me halfway thru feeding but she gives in easy enough to let me feed her a little more. Im really hoping tomorrow brings some good news and maybe she starts to feel better. Thank you and everyone else here for all the help lately

Just a small update: I just got another urine sample for the ketone strips and it came back "small". Ive been feeding her with the syringe every 2-3 hours, depending if shes sleeping or not(i try to let her rest when she looks comfy).

3. Continue to syringe feed, aim for every 2 hour feedings. Try to get a 5.5oz can of food in her each day.

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Per Meya's and Dyana's recommendations try to keep to feeding Mittens every couple of hours. I understand more than you'll ever know how emotionally tough it is to see your furbaby sick and yet still have to keep doing things to help - and assist feeding can feel very stressful.

While in an ideal world it would be lovely to let Mittens rest, right now she needs you to be extra strong for her, wake her and keep assisting her to take on board food and fluids to keep the ketones at bay. Please try not to feel guilty about waking her; you are acting out of love.

When you get the insulin tomorrow (and you will!) it will be a big step forward but for now the calories and moisture from the food are what your dear girl needs most. I really do understand how hard this is and I feel for you all.

(((Dan, Heather & Mittens)))

You're both doing an a-mazing job. Mittens is indeed blessed to have you both. I hope the Pepcid will help.

Hi, it's Heather. I see Dan has updated you while I've been at work. Yes we are going to start caring for her in shifts which will make sleeping much much easier. Neither of us has had much sleep at all for the last week or so.

Will the insulin take care of ketones?

Also, we got an email from DCIN. They praised us for feeding her fancy feast and for joining this forum they said there is tons of information on here for us. They requested a copy of the prescription because I didn't have one to send yesterday. I emailed back and explained that we are getting it tomorrow morning and that I will send them a copy as soon as its in my hands. Hopefully they can help us a little, that would be incredible.

Thank all of you again, we will keep you updated. Dan is keeping me informed while I'm at work. I feel bad that he has to be there and do it alone for most of the night tonight, but work must happen unfortunately.

I'm going to go thru the while thread again when I get home and make more notes so I am as prepared as possible for the appointment tomorrow.

make more notes so I am as prepared as possible for the appointment tomorrow

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I suggest printing out the IDEXX document. You couldn't wish for a more reputable and authoritative source for nausea treatments, appy stimulants, pain relief, etc. All of the meds we've told you about are discussed in that document.

Just as I read that Dan was telling me I need to go to sleep. I can take a nap after the vet, so not a big deal. I just read through the whole thread about 3 times trying to make sure I understand everything. I am going to sleep for a few hours then we'll be off for the vet again. Dan got a little bit of sleep right before I got done working tonight. We have fed her a few times from the syringe since i've been home because she still wont take more than a couple licks of food off of a plate. She drank a little bit of water after I got home, we gave her a little more in the syringe a little while ago. I'm hopeful for the vet visit later today, I'm glad we will finally be getting some things that might actually start helping her. I will post again when we're getting ready to leave in the morning and when we get back.

I know it's tough going at the moment but it would be great if you could do a blood glucose test for Mittens BEFORE going to the vet so you know what her levels are at home. This is important for dosing the insulin properly. The vet visit might make her levels higher than normal so if you have the home test done you'll be able to compare. If your vet uses a pet meter this is also likely to read higher than your human meter.

I didn't see the message about testing her glucose before we went. We just got back.

They did blood work and tested her urine, she said her electrolytes are low, her white blood cell count is high, she told me the blood cells could be because of an infection or a tumor or cancer or just because she's sick and her body is trying to fix itself and said more tests would be required to find out anything about that. She said her potassium is low, on this paper the number is 2.5mmol/L. I hope that's the right number I'm looking at, here's a link to a picture of the paper I got today http://imgur.com/a/g8z9W She told me she has some ketones in her urine but said with the things we're gonna do they should go down. They gave her fluids and showed me how to do it, she got a shot of B12 and they gave her cerenia for anti-nausea. She sent me home with potassium supplements and an appetite stimulant Mirtazapine along with a bag of fluid and the line and needles to give it to her. She said we can give her 100ml either once every 24 or 48 hours depending on how much fluid she is taking in.

She walked around for a few minutes when we got home then went behind the couch for about 10 minutes then came out and drank a tiny bit of water. She didn't want anything to do with the food we tried a few minutes ago, so we fed her some from the syringe. The appetite stimulant pills are pretty small and it says to give her half of one at a time so I'm not too worried about that, although we haven't given it to her yet. The potassium tablets are concerning me though because it says to give her a whole tablet twice a day for two weeks and they are bigger than I thought they would be. They're roughly the size of an aspirin pill for humans and I don't know if we'll be able to get her to take it.

The appointment was more expensive than they estimated for me on the phone. They said this was because they weren't sure if I was going to want the B12 for sure so they didn't add it in, and because of the cost of the appetite stimulant and potassium tablets. I sent a picture of the prescription for insulin to DCIN as soon as I got home, it's getting very very close to their help being the only way I can start her on insulin. The kind they wrote it for is Glargine and it says on there that it can be substituted with generic. I think that's all the information from the vet visit.

This was the first appointment with them where nobody suggested we put her to sleep. I think they understand at least a little now that we fully intend to try treating this and are not giving up just yet. I'm worried about her eating, she is fighting us more and more it seems each time we try to feed her with the syringe. I know she must hate it as much as we hate doing it but yesterday she seemed to take it alot easier than today. I know she must have been aggitated from being at the vet for almost two hours though, I'm hoping maybe when she calms down it might go a little easier. The vet gave me a couple of printed off sheets of information about diabetic cats and how to treat and care for them. When she gave them to me I was confused about why they didn't give me that at our first appointment, but I'm sure it was because she gave up hope on Mittens immediately upon meeting her and didn't think we were going to need that information. She should provide this information to anyone who has a cat diagnosed with diabetes anyway I feel.

So very soon we're going to attempt to give her the appetite stimulant. They said I could give it to her whenever after I got home. Should I wait and let the anti-nausea medicine have time to try to work or should we give her this right now?

Oh yeah, she also asked me if I intend to test her glucose at home. I said I'd like to and she seemed ok with it at first saying I should call in with the results so they can adjust dosage. Then she said she'd be reluctant to go with the number on our monitor because it's for humans not for animals and suggested I buy one for animals online and said I should just let them do the testing there so they know it's accurate. At this point I just did what you said to do and just kinda went along with it and then just let that subject pass. They said we'd have leave her there overnight so they can do the curve thing. I'm not going to do that, Mittens would go nuts if I dropped her off and then just left.

So very soon we're going to attempt to give her the appetite stimulant. They said I could give it to her whenever after I got home. Should I wait and let the anti-nausea medicine have time to try to work or should we give her this right now?

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Don't give the appetite stimulant for the moment.

Need to check dosage - sometimes vets prescribe too high a dose and mirtazapine is quite strong. (Anti-nausea needs a little time to kick in before giving appy stimulant.)

The appetite stimulant pills are pretty small and it says to give her half of one at a time so I'm not too worried about that, although we haven't given it to her yet.

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Just a suggestion...
A half tab of mirtazapine aka Remeron is usually too much for many cats. When the dose is too high, they'll often vocalize incessantly, pace, act nervous, and/or act completely "out of it". If I were in your shoes (and have been), I'd start with 1/8 to 1/4 tab (think slivers of the pill). A tiny bit goes a long way. You can always give a bit more if necessary.

The potassium tablets are concerning me though because it says to give her a whole tablet twice a day for two weeks and they are bigger than I thought they would be.

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Try crushing the potassium tabs into a fine powder. If Mittens will eat, you can mix it in a little food. It'll go down easier mixed in food. If not, mix the potassium powder and a little water in an oral syringe and give it to him that way. Follow it with a water chaser... about 4 - 5 ml of water.

Edited to add: An inexpensive pill cutter found at any drug store will come in handy!

Ok, I thought maybe we should let the anti-nausea work for a bit before giving her the appetite stimulant. I think someone here said something along those lines the other day and that's why I thought we should wait a little bit.

She weigh's just barely under 8lbs. God she has lost alot of weight in the last week..

I wish they could have started her on some insulin right away. Will your vet be okay with starting with some Novolin N from Walmart? I think it's about $25.00 for a vial. It's not the best for kitties as it is fairly strong and only lasts about 8 to 10 hours, but would be better than nothing for now, until you get some Lantus (Glargine) shipped to you.
What was her glucose number?

I wish they could have started her on some insulin right away. Will your vet be okay with starting with some Novolin N from Walmart? I think it's about $25.00 for a vial. It's not the best for kitties as it is fairly strong and only lasts about 8 to 10 hours, but would be better than nothing for now, until you get some Lantus (Glargine) shipped to you.

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Dyana, would you be able to help Dan and Heather with Novolin dose, or do you know which members could help?

Dyana, would you be able to help Dan and Heather with Novolin dose, or do you know which members could help?

Mogs
.

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I only know Lantus and Levemir well. My cat started on PZI or Prozinc but that was a long long time ago.
I did a search on the "Novolin N" in the search box on the board and there were a lot of hits. Maybe, she could start a new thread on the Health Forum with a subject line of "Novolin N help, please" or something like that, and making sure to state in the initial post that Mittens is not eating regularly and being assist fed at the moment. I hope they can get some insulin into Mittens soon. I could only guess at starting with 1 unit or even 0.5 unit since she's not eating much, and testing. Make sure they have gravy and syrup or honey and the whole hypo kit, including lots of test strips. I wish they lived closer.

Regarding the potassium, once you get her level up, she will probably have less nausea and a lot more energy. Low potassium can cause the digestive system to slow to a halt. Be aware though that it's best to give with food as it can irritate the stomach at first if the stomach is empty. Also, it may cause some loose stools, don't be alarmed if this happens. You can crush and mix it with the food you are feeding.

The faster you can start insulin, the better your chances of getting her healthy. I agree, novolin N would be better than nothing at the moment. Also, you may want to put a shout out in your social network - a lot of human diabetics throw out insulin after 30 days (after it expires) so they may be able to give you the leftovers - for free! Only take vials form people, not pens, as humans usually use pen needles which contaminate the pen and could expose you to germs (hepatitis) if you had and accidental needle stick. Don't take from people who re-use needles either for the same reason.

Yes that was good information. We will start with only a very small portion of the pill. And for the potassium I was hoping someone would say that way would be ok, that's the way I think we'll have the most success. We are going to try it in a few moments, after that we will get a glucose reading and let you know what it says.

Agree with getting N insulin started, it's better than nothing. Don't know how long it will take DCIN to get it to you since its the holidays.

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Is that the one I can get at walmart over the counter? If so should I go get some right now? I need to go get more baby food anyway and can ask about it while I'm there, we do have enough money left for that one if we need it tonight.

We did get an email from DCIN here is what it says:
Hi Heather,
Thank you for the prescription and it sounds like you & Mittens had a productive vet visit!
I know this is a very stressful time for you right now, we have all been in your shoes when it comes to caring for a diabetic kitty at one time (even myself). The reason I asked for the prescription is so that we can work on getting you the insulin and syringes.
I have your file set up and I am just waiting for confirmation that your application has been approved (I don't see it being a problem but I have to go through the proper channels before I can official say yes). Hopefully I can have a decision for you shortly. In the meantime please continue with what you are doing, your are doing the best you can for Mittens and that is all we ever want!
Could you please send me a picture of Mittens when you have a minute?
-Jennifer

Sounds like a positive email to me. Should I wait to see what the next email says or will it take a while to get it to us even if we are approved. If that's the case I and if the one from walmart can be gotten without a prescription I will go get some right now. We are going to try to feed her and get the potassium in her right now.

Is the vet near you? Could you phone in a request for an Rx for Cerenia tablets?

Stress that it's the Christmas weekend and you want to make sure that you've got enough meds to cover Mittens' needs over the holiday. Even if she only gives you a handful of doses it would help the situation. Perhaps you might be able to pick up the Rx on your way to the store? (I'm very conscious of it being the weekend and, presumably, the vet office being closed.)

(An aside: a lot of vets prescribe appy stimulants for nauseated cats without also giving an Rx for anti-nausea meds. It's very frustrating because the key to getting appetite back is tackling the nausea.)

Also can you look at this thread for things to pick up from the store when you go out to get your baby food supplies:

In particular be sure to pick up karo or honey (unless you already have some in the house) and a few cans of Fancy Feast Gravy Lovers cat food (the gravy has a lot of carbs and helps raise BG numbers quicker than regular food). A pack of Temptations treats would be good too.

Let us know what her blood glucose test is, and what was it at the vet today?
I would try to start her on insulin ASAP, like tonight if possible. She has waited long enough. Do you have plenty of test strips? You may need to test often (like every hour or two) once you start insulin (especially the Novolin, which like I said can be not as gentle as Lantus), and you will need some food with higher carbs like the ones that have gravy or some honey or karo syrup. Do you have those?

I've never done this before, but if it's possible to do, I can phone in a small Walmart Gift Card for you to pick up to help you pay for things, tonight.
I hope someone can chime in on what dose of Novolin N would be okay to start with. If you get the insulin be sure it's Novolin "N" and not Novolin "R".

They are open until 9pm. I have to leave for work in less than an hour though

The vets office closed at 5, but they are open tomorrow till 1:00, so I will call about more cerenia.

We have a bunch of the strips left. We just crushed up the potassuim pill and mixed it with baby food and gave it to her. She is fighting us very hard on the syringe feeding so she probably only actually got half of it in her mouth but that's got to be better than none, right? I hope. I'm going to walmart now. I'm going to get fancy feast gravy lovers and honey and novolin N. I will have the message board open on my phone so please let me know if I have more stuff we need to get. We are a little limited on money now but I have enough for those things I just mentioned. Also, I know we need syringes, can someone tell me what size or gauge or whatever I need to get. Sorry, I know someone already said so but I feel like I need to take off for Walmart right now so I dont want to scroll thru all the messages. Thank you

Ask them for the ones with 1/2 unit markings. The Walmart pharmacy people often don't know they have them, but ask them to look. The 1/2 unit marks just help to fine tune the dose. They should be around $12.58 for 100. You can use them for the Lantus insulin when you get it, too.

My help with dosing Novolin-N would be limited to my knowledge of this insulin in humans. I've never used it in cats. I feel that starting at a negligible dose (less than 1/2 unit, or about 1/4 unit three times a day) and working up would be safe. Three times a day dosing would be preferable to prevent steep drops and to provide full day coverage with this insulin.

Off topic - novolin-N is actually a slightly better insulin to use in this situation because it won't have as much potassium lowering effect as lantus does.

I'm back from walmart. I got novolinN, syringes, fancy feast gravy lovers, and honey. We are going to test her glucose in a minute to see where it is. I will post that in just a few minutes. I can be about 2 hours late for work tonight which gives us about 2 hours from now since right now is when I should be leaving, after that Dan is going to be on his own until I get home around 3:30am so I need to know what we need to do right now. Do we start with a very small dose of insulin right after we test the sugar? How long after insulin should we retest? Sorry I feel this post is frazzled, but that's because I am right now.

I can't think of any interactions with low K and mirtazapine, other than heart arrythmias, but that's a risk with the low potassium either way. It might make kitty a little lethargic or goofy especially at first. I really wouldn't worry too much about starting it now or starting it in a day or two. Likely, she will still need to be syringe fed for a few days until other things are fixed, so it's not priority.

NPH insulin onset is about 1-2 hours, peak 2-6 hours and duration 8-10 hours give or take with some residual effect up to 20 hours. Insulin metabolism is faster in cats. So for your initial couple doses I would test at +2, +4, +8 in each cycle at the minimum. Does anyone have a copy of the spreadsheet for 3 times a day dosing?

We filled the syringe to 10ml we probably got half maybe a little more actually into her because she's fighting it. I'm worried right now because I'm down to the wire, I have got to leave for work in about half an hour and Dan has been up all last night and today, I dont think he's going to be able to stay up long enough to check her sugar and monitor her while I'm at work. So I dont know if we should do the insulin with nobody to watch her closely. I wish it was tomorrow, I have the day off and can spend all of it with her. What do you think I should do because he's not going to be able to stay awake?

This may not be perfect math, but this is the formula I used to use for J.D. to figure out how many calories he was getting.
I often had to give 3 or 4 syringes in the wee hours of the morning, wait an hour, and give another 3 or 4, then go to work. I would feed another 3 or 4 when I got home from work, and another 3 or 4 before I went to bed.
I figured my syringes had about 16 calories each. Maybe my math was wrong.
Anyway, I have to log off for an hour or so.